Assessing changes in cancer-related financial support needs across three waves of the COVID-19 pandemic.
Authors: Bridgette Thom, Andrea Incudine, Neha Arora, Thomas Stivers, Katharine Winder, Fumiko Chino
Journal: Journal of Clinical Oncology (2023)

e18584 Background: Cancer-related financial hardship is well-documented and associated with treatment/medication nonadherence and poor outcomes. Family Reach is a national nonprofit that aims to remove financial barriers to cancer treatment through education, resource navigation, financial coaching, and direct financial assistance. We sought to evaluate variation in patient financial support needs throughout three waves of the COVID-19 pandemic: March-December 2020 (Wave 1), January-December 2021 (Wave 2), and January-June 2022 (Wave 3). Methods: Applications for Family Reach services were evaluated. Descriptive statistics and univariate tests characterized responses, and multivariable analysis, considering age, race/ethnicity, insurance, gender, insurance, % of federal poverty level (FPL), and children &lt; 18 in the home, assessed associations between pandemic wave and self-reported financial and essential needs concerns. Results: From 3/2020-6/2022, 10679 applications were processed: 39% in 2020, 38% in 2021, and 24% in 2022. When relationship to the patient was specified (62%, n = 6647), most applications were submitted by a parent (53%) or the patient (28%). Common diagnoses included leukemia (26%), breast cancer (16%), sarcoma (8%), and lymphoma (7%). Patients were a median age of 30 years (IQR: 11-46); racial/ethnic identity included 41% Non-Hispanic White, 24% Non-Hispanic Black, 21% Hispanic patients; 53% had a child &lt; 18 years at home. Median %FPL was 123.2 (IQR: 68.3-207.6): 54% reported losing income because of the pandemic, with a greater than expected proportion experiencing income loss in the Wave 2 (Wave 1: 49%, Wave 2: 59%, Wave 3: 54%; χ 2 = 67.0, df = 2, p &lt; .001). Financial concerns across the entire sample included medical expenses (50%), nonmedical expenses (61%), childcare costs (17%), and food insecurity (42%). One-third (33%) were at risk of utility shut off within the past 90 days. In multivariable analyses, concerns about medical expenses were higher in Wave 2 (OR = 1.8, 95% CI: 1.5-2.1, p &lt; .001) and Wave 3 (OR = 3.2, 95% CI: 2.7-3.9, p &lt; .001), when compared to Wave 1. Past 90-day-risk of utility shut off (Wald = 26.0, p &lt; .001), food insecurity (Wald = 46.7, p &lt; .001), and childcare concerns (Wald = 26.0, p &lt; .001) were higher in Wave 1 when compared to Waves 2 and 3. General nonmedical needs were consistent across all three waves of the pandemic (Wald = 1.28, p = .53). Conclusions: Although the early months of the COVID-19 pandemic led to high rates of immediate essential needs in patients with cancer, nonmedical financial concerns remained consistent, and medical financial concerns rose over time. Given ongoing financial gaps in care delivery for the most vulnerable, financial assistance and other services through programs like Family Reach will continue to be a key resource for patients and families, but structural and policy-focused interventions are needed for sustainable change.